Abstract

Background:Hematometra is an uncommon disorder that can be caused by congenital or acquired structural obstruction of the cervical canal. Acquired cervical stenosis can develop due to surgical procedures performed on the uterus or cervix. Common symptoms associated with this disorder include amenorrhea or dysmenorrhea in premenopausal women, pelvic pain or pressure, urinary frequency and retention. We report a case of hematometra and hematocolpos, secondary to cervical canal occlusion treated with ultrasound guided placement of lacrimal probe.

Case:A 41-year-old G1P1001, non-pregnant woman presented to our clinic in October 2015 with complaints of two months amenorrhea after gradual progressive pelvic pain, pelvic pressure and dysmenorrhea since 2014. She had a history of one normal spontaneous vaginal delivery and her surgical history was significant for a Loop Electrosurgical Excision Procedure (LEEP) in 2009 followed by a cold knife cone biopsy in 2014 for management of recurrent cervical dysplasia. Pelvic exam showed complete occlusion of cervical canal as well as a palpable boggy uterus. The patient was scheduled for Dilatation and Curettage (D&C) with ultrasound guided placement of a lacrimal probe for management of cervical stenosis, hematometra and hematocolpos.

Conclusion:In the work up of a patient presenting with pelvic pain and secondary amenorrhea with a history of a Loop Electrosurgical Excision Procedure (LEEP) or cone procedure, the diagnosis of cervical stenosis and subsequent hematometra should be considered. Although management is simple, it can be complicated by a high rate of recurrent stenosis for which there is no definitive solution. Early recognition and treatment prevents severe complications of hematometra such as uterine rupture, infertility and endometriosis.

Keywords

Cervical Canal Occlusion; Cervical Conization; Cervical Dilatation; Cervical Dysplasia; Cervical Obstruction; Cervical Scarring; Cervical Stenosis; Cone Biopsy of Cervix; Cytotec; Hematocolpos; Hematometra; Hymenectomy; Lacrimal Probe; LEEP; Loop Electrosurgical Excision Procedure (LEEP); Misoprostol; Ultrasound Guided Dilatation and Curettage (D&C); Uterine Cervical Stenosis; Uterine Rupture